344 Ch 343. Nephrolithiasis (Kidney Stones)

Nephrolithiasis 全球盛行率上升 (~ 12% 男, ~ 6% 女 lifetime)；台灣盛行率高（飲食 + 缺水）；five stone types：(1) calcium oxalate (most common, ~ 70-80%), calcium phosphate (~ 5-10%)；(2) uric acid (5-10%) — 酸性 urine, gout, 高 purine；(3) struvite (5-10%) — magnesium ammonium phosphate, urease-positive bacteria (Proteus, Klebsiella, Pseudomonas, S. aureus)；(4) cystine (1%) — autosomal recessive cystinuria；(5) drug-induced (acyclovir, indinavir, sulfonamide, triamterene)；acute presentation: renal colic (severe flank pain, radiating to groin), hematuria, nausea；diagnosis: non-contrast CT is gold standard (> 95% sensitive, all stone types)；US for pediatric / pregnant；management：< 5 mm pass 80%; 5-10 mm pass 50%; > 10 mm < 25%；medical expulsive therapy (MET): tamsulosin for ureteral stones 5-10 mm (mixed evidence — SUSPEND trial 2015 negative)；urgent intervention: obstruction + infection (urosepsis) = surgical emergency；procedures: ureteroscopy with laser lithotripsy, ESWL (extracorporeal shockwave lithotripsy), PCNL (percutaneous nephrolithotomy)；prevention: hydration + dietary modification + specific therapy (potassium citrate, thiazide, allopurinol, etc.)。